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Electronic Health Records

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NCPC T he National Center for Primary Care (NCPC) has the unique distinction of being the only congressionally sanctioned center in the country dedicated to promot- ing optimal health care for all, with a special focus on serving underserved communities. Headquartered at the Morehouse School of Medicine, the NCPC is committed to the pursuit of a healthier nation.

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Setting theRecordsStraightA fter Hurricanes Katrina and Rita pounded the Gulf Coast last year, countlessnumbers of hospitals, community healthcarecenters, and doctors’offices were destroyedby Katrina’s fierce Electronic Health Records (EHRs)wind and flooding. are digital medical records of theEven more physical and mental health of adevastating was thatmost of the 1 million patient. The data includes patientresidents displaced by demographics, progress notes,the storm were left physician notes, medications,with no medical vital signs, past medical history,records. immunizations, laboratory dataFlooding from the and radiology reports.storm and thebreaching of levees inLouisiana damaged ordestroyed paper medical records stored in boxesin hospitals, clinics and physicians’ offices.For the Regional Coordinating Center forHurricanes Response at the National Center for 15

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Primary Care at the Morehouse School of Medicine, Hurricanes Katrina personal health profile stored on it.and Rita have been the loudest wake-up call for supporting the need for Using a statistical model, RAND researchers, a nonprofit researchelectronic health records (EHRs). organization in Santa Monica, CA, recently tabulated that the cost savings“We must have a sustainable model for transitioning our community of implementing EHRs system that included 90 percent of hospitals andhealth centers and hospital to electronic health records. This model must doctors could save $81 billion annually and improve the quality of care.also be a replicable system that will benefit the entire nation and serve as a U.S. Department of Health and Human Services Secretary Mike Leavittsafety net for future disasters, man-made or natural,” said Dr. Dominic recently selected 16 commissioners to serve on the American HealthMack, director of the Regional Coordinating Information Community. The federalCenter for Hurricane Response at the National commission will advise Leavitt on how toCenter for Primary Care. WHY SHIFT TO EHRs? achieve the President’s goal of making healthUltimately having a web-based solution that • Reduces Medical Error information digital and having most of the U.S.everyone can access is optimal. Initially however, health care system using interoperable“increasing the portability of health records and • Improves Quality of Care electronic health records within 10 years. Ifgiving more control of healthcare to patients achieved, the hope is that the patients’ medical • Lowers Long-Term Costsshould be the number one priority for community information can be accessed immediately andhealth centers in the regions affected by Hurricane efficiently, helping to reduce medical errors, • Eliminates Paperwork HassleKatrina, according to Dr. Mack. improve quality, lower costs and eliminateWhen emergencies and natural disasters arise, • Can Offer an Alternative Secure paperwork hassle.safety advocates advise people to prepare survival Location to Back-up Records in Switching from paper-based to digitallykits that include, in addition to food, water and the Event of a Disaster encoded medical records offers several practicalclothing, important health records and a list of advantages. It not only ensures data recovery intheir medications/vitamins. the event of a natural or man-made disaster,“There are two sides to the digital healthcare equation, EHRs and personal EHRs can also streamline practice operations, allowing the flow of thehealth records (PHRs)”, says Dr. William Alexander, director of the office or practice to run more efficiently. EHRs also have multiple clinicalHealth Policy Institute at Morehouse School of Medicine. The short-term implications for improving the quality of care of patients.goal for people displaced by Hurricane Katrina is to equip them with their “EHRs allow for data integrity, data recovery, decreases data redundancyPHRs.” This was a major initiative undertaken in partnership with the and provides tools to manage information more efficiently,” says Dr. SteveRegional Coordinating Center for Hurricane Response, the New Orleans Waldren, assistant director for health information technology at theHealth Department and Intel during the week-long health fair in New American Academy of Family Physicians’, Center for Health InformationOrleans in February 2006. Several thousand attendees had their health Technology (Center). The Center collaborates with government, industry,information uploaded into a database and were given a CD with their and other professional organizations to apply health information technology to improve patient care and safety, and to increase the efficiency of health care delivery. “EHRs create a better plan for treating the health needs of people vs. a paper-based system.” Dr. Waldren said. According to Dr. Waldren, EHRs allows physicians to better plan at the local and state level. “EHRs have the potential to create a community network across community health centers…potentially enabling physicians More than 250,000 who practice evidence-based medicine to aggregate data to provide better evacuees needed care” and anticipate the needs of the population more effectively and on- medical attention and were separated demand. from their medical Furthermore, it also has the potential to advance “population-based records. healthcare by tracking trends (i.e. bio-surveillance evidence) and emerging 16

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diseases (i.e. influenza)” in order to assess the health needs of a specific seeing patients as well as reduces revenue,” said Dr. Waldren. “Loss ofpopulation to leverage health promotion and disease prevention efforts. productivity due to staff training and time off for configuration” are alsoDr. Harry Strothers, assistant professor of gerontology at the Morehouse major challenges one must consider.School of Medicine says EHRs enable physician’s to manage the “quality According to Dr. Mack, it is most feasible for the Regional Coordinatingof care” of patients. Center to assist community health centers“CMS (Center for Medicaid and Medicare CHALLENGES TO EHRs located in larger cities to implement a PHRsServices) and other insurers are asking • Data Integration – ensuring system during the first phase of the grant.physicians more frequently if preventative compatibility with other Once this phase has been successfullymeasures and best practices are being adhered systems completed, the second phase can concentrateto (i.e. pap-test, mammogram, etc.). EHRs on developing a strategy for a comprehensivecan help you gather the data quickly vs. piece • Demonstrating Value web-based EHRs system.milling it from paper charts,” said Dr. – displaying the ability to In order to optimize a EHRs system, there demonstrate market valueStrothers, who has been studying the benefits must also be a “champion.” An individual among academic institutions,of EHRs for several years. who enthusiastically shoulders the community health centers,For example, while a patient is visiting their responsibility of acting as the “resident and primary care associatephysician, clinical reminders can be set-up to expert” and spokesperson on the EHRsautomatically alert the physician to schedule • Data Back-up – securing all system. That champion may be formertheir patients’ next appointment. data in clinic to backed-up House Speaker Newt Gingrich. As thePatient education can also be enhanced by drives off site at a fire-proof founder of the Center for Health flood-resistant locationcreating a program to find educational Transformation - a public/private partnershipmaterials in text or graphics for low-literate • People – changing the way trying to push technological reforms into thepatients for specific diseases while patients are physicians traditionally health care system - Gingrich is workingin the clinic. In addition, EHRs also allow practice medicine and gather with Morehouse School of Medicine to callphysicians to optimize disease management data may be biggest challenge on Congress to pass legislation that wouldoutcomes and best practices to ensure they’re protect citizens’ personal information.following specific guidelines for common chronic illnesses and diseases, Security and privacy are major concerns that practitioners and patientssuch as diabetes, heart disease, obesity and cancer. have expressed as being a barrier.“If you pick the right system, there are lots of benefits”, Dr. Strothers said. “The number one lesson from Hurricane Katrina...paper kills!,” saidIf implemented broadly physicians have expressed major concerns, namely Gingrich. “Every American should have an EHR by the end of next year.”cost and security.On average, the start-up costs can easily exceed $1M, according to Dr.Alexander. In addition, the on-going maintenance fees are usually two-thirds of the initial costs. “The up-front cost is significant and there isusually not a return on your investment until the end of year three,” saidDr. Alexander. Given that there are more than an estimated 140community health centers in the Gulf Coast, implementing EHRs wouldbe an astronomical expense.However, the direct cost of purchasing the hardware, software and annualmaintenance alone can be overwhelming for a small office or communityhealth center. Not to mention the indirect costs of implementing thesystem.“Some physicians have to decrease the amount of patients they see duringthe first six months during implementation…this can eat into their time 17